I orea te tuatara ka patu ki waho: A journey of collecting Indigneous healthcare experiences

IntroductionAs this research focuses on Māori health within rural settings, it highlights key features of the Aotearoa New Zealand (Aotearoa) health system and experiences of Māori in rural areas throughout Aotearoa.A general overview of four key areas that supported the development of the aims of this research are explored in the introduction: Healthcare system of Aotearoa, rural healthcare in Aotearoa, Indigenous healthcare experiences and Indigenous healthcare experiences of Māori (Indigenous peoples of Aotearoa) in Aotearoa. A brief literature search identified a lack of published literature investigating or reviewing experiences of those seeking healthcare in Te Tai Poutini (West Coast, South Island, Aotearoa), highlighting a knowledge gap. This thesis seeks to collate experiences and knowledge to fill this gap and create opportunities for further research in this region.A scoping review was completed, exploring lived experiences from Indigenous communities accessing health services in rural areas of Canada, Australia and Aotearoa, supporting the development of the qualitative analysis research questions. AimThe aim of this research was to explore, understand and analyse the lived experiences of Māori who access rural healthcare services in Te Tai Poutini (West Coast, South Island, Aotearoa). MethodsThis thesis contains two distinct pieces of research, although the results and discussion are intrinsically linked. A scoping review was undertaken, "Rural Indigenous community experiences of healthcare services: a scoping review", exploring experiences across Aotearoa, Australia and Canada.The scoping review informed the research questions for the qualitative research component, "A qualitative analysis of healthcare experienced by rural Māori". This semi-structured qualitative research included two focus groups and five interviews, completed by the research candidate (TC) and one supervisor (LK). These results were analysed following a general inductive approach. ResultsSeven articles were included in the scoping review and five themes were identified. The five themes which impacted the healthcare experiences of Indigenous peoples included: distance to care; quality of care and racism; support from, and impact on, whānau (family); health professional communication and knowledge sharing; and Indigenous solutions and holistic care. The lived experiences of eleven Māori living in rural Te Tai Poutini (West Coast) identified five overarching themes; when care is shaped by relationships and distance, physical environment, medicines information needs to be communicated effectively for informed decision making, value of rongoā, and compassion for whānau and empowerment. DiscussionConsidering the diverse experiences shared across both research activities, it is apparent that although many factors impact Indigenous peoples’ access to healthcare, they cannot be easily modified by singular, simple interventions. However, several possible strategies have been identified during data analysis, including emphasising the importance of flexible communication techniques for health professionals when working alongside patients and their whānau. Importance was placed on not making assumptions of Indigenous patients’ health knowledge and choice of health professional. Providing culturally inclusive care is paramount for ensuring the voices of Indigenous peoples are heard when accessing health services and allowing them to fully engage in their healthcare journey, demonstrating autonomy and self-determination. Health professionals must think critically and familiarise themselves with concepts of whakawhanaungatanga (building and maintaining relationships)iv and Māori and Indigenous models of health. Rurality is a non-modifiable factor that exists for many whānau Māori, creating complexities when navigating a health system that is not well- designed for Indigenous peoples. Layers of costs relating to rurality, not just financial, add to the burden. These factors must be considered in order to provide culturally safe, accessible and appropriate care with Indigenous peoples.